We recognize that in the office setting, some specific laboratory values and other patient data are not always readily available. This also may include timely access to published scientific studies that can support clinical decision-making. Appropriate Use Criteria (AUC) specify when it is appropriate to perform a clinical procedure or service. An “appropriate” procedure is one for which the expected health benefits greatly exceed the expected health risks. Ideally, AUC are evidence-based, but in the absence of sufficient evidence, may be derived from a “consensus of expert opinion” and “accepted practice”.

With this AUC, we have attempted to define clinical situations in which antibiotic prophylaxis in certain at-risk dental patients could reduce a theoretical risk of post-surgical prosthetic joint infection. This AUC was developed as a decision support tool to facilitate the treatment of defined "high risk" and "immune compromised" patients who are on the more severe end of the clinical spectrum of disease. In the absence of readily available laboratory data or suggestive clinical suspicion, it would be reasonable to assume that most patients will fall outside of these criteria and therefore lay outside the confines of our strict definitions. As always, sound judgment should guide clinical decisions about when it may be necessary or prudent to delay a dental procedure until more information is available.

Assumptions:Planned Dental Procedures

The chance of oral bacteremia being related to joint infections is extremely low, with no evidence for an association.

Oral bacteremia frequently occurs secondary to activities of daily living such as tooth brushing and eating.

Virtually all dental office procedures have the potential to create bacteremia.

Immunocompromised Status

Severely immunocompromised patients include:

Patient with Stage 3 AIDS as defined by the Centers for Disease Control and Prevention (CDC) Guidelines when the immune system becomes severely compromised due to reduced CD4 T lymphocyte counts (<200) or opportunistic infection as defined by CDC8 see list of diseases below.

* Only among children aged <6 years.† Only among adults, adolescents, and children aged ≥6 years.§ Suggested diagnostic criteria for these illnesses, which might be particularly important for HIV encephalopathy and HIV wasting syndrome7, 8